What is the optimal timing for the last dose of Novolog (insulin aspart protamine/insulin aspart) 70/30 when taking Lantus (insulin glargine)?

Timing of Novolog 70/30 When Using Lantus

When using both Novolog 70/30 and Lantus (insulin glargine), the last dose of Novolog 70/30 should be administered 30 minutes before dinner, with Lantus typically given once daily at bedtime or in the morning. 1

Understanding the Insulin Regimen Components

• Novolog 70/30 is a premixed insulin containing 30% soluble insulin aspart (rapid-acting) and 70% protamine-crystallized insulin aspart (intermediate-acting) 2
• Lantus (insulin glargine) is a long-acting basal insulin with no pronounced peak and approximately 24-hour duration 3
• This combination represents a modified basal-bolus regimen that provides both prandial and basal coverage 3

Optimal Administration Schedule

Novolog 70/30 Administration:

• Administer twice daily, 30 minutes before breakfast and dinner 1
• Morning dose: Covers breakfast and provides some basal coverage until lunch/afternoon 3
• Evening dose: Should be given 30 minutes before dinner to effectively cover the evening meal and provide partial overnight basal coverage 1

Lantus Administration:

• Administer once daily, either at bedtime or in the morning 3
• Provides consistent 24-hour basal insulin coverage without pronounced peaks 3
• Helps maintain stable blood glucose levels between meals and overnight 3

Avoiding Insulin Stacking and Hypoglycemia

• Important safety consideration: The evening dose of Novolog 70/30 should be timed to avoid insulin stacking with Lantus 3
• The intermediate-acting component (70% protamine-crystallized insulin aspart) of Novolog 70/30 has a duration of approximately 12 hours 2
• Administering the evening Novolog 70/30 dose too late (e.g., at bedtime) could lead to overnight hypoglycemia when combined with Lantus 3

Special Considerations

• For patients with unpredictable eating patterns, postprandial dosing (15-20 minutes after meal onset) may be an acceptable alternative to standard preprandial dosing 4
• Elderly patients may benefit from this flexibility in dosing time, as it allows them to adjust insulin based on actual food consumption 4
• For patients on enteral bolus feedings, administer approximately 1 unit of insulin per 10-15g carbohydrate before each feeding 1

Monitoring and Dose Adjustments

• Monitor blood glucose before meals and at bedtime to assess the effectiveness of the regimen 3
• If fasting morning glucose levels are consistently elevated despite adequate evening Novolog 70/30 dosing, consider:
  • Adjusting the Lantus dose 3
  • Moving Lantus administration from bedtime to morning 3
• If postprandial glucose levels remain elevated after dinner, consider:
  • Increasing the evening Novolog 70/30 dose 1
  • Adjusting the ratio of carbohydrates consumed at dinner 1

Alternative Regimens to Consider

• If glycemic targets are not achieved with twice-daily Novolog 70/30 plus Lantus, consider:
  • Advancing to three-times-daily premixed insulin 3
  • Switching to a full basal-bolus regimen with Lantus plus rapid-acting insulin at each meal 3
  • Adding a GLP-1 receptor agonist if appropriate 3

By following these timing recommendations, patients can optimize glycemic control while minimizing the risk of hypoglycemia when using both Novolog 70/30 and Lantus insulin regimens.